Clarithromycin regresses endometriotic implants in rat endometriosis model.

The aim of this study was to investigate the effect of clarithromycin in rat endometriosis and its association with matrix metalloproteinase-9 (MMP-9) expression. After surgical induction of endometriosis, 27 rats were randomised into three groups. Size of endometriotic implants were evalutated and rats in group I (n = 9) were given 100 mg/kg/day of oral clarithromycin, rats in group II (n = 9) were given single 1 mg/kg s.c. injection of leuprolide acetate and rats in group III (n = 9) were not given any medication for 21 days. At the end of 21 days of medication, remaining 23 rats were sacrificed to evaluate morphological and histological features of implants. There was a significant difference between the groups in implant volumes (p = 0.004) before and after medication. Regression of implants were significantly higher in groups I and II than that in control group (p = 0.009 and p = 0.011, respectively). After medication, in group I the implant volume decreased from 62 (12-166) mm(3) to 26 (3-87) mm(3) (p = 0.012) and in group II the volume decreased from 224 (76-1135) mm(3) to 62 (26-101) mm(3) (p = 0.028). There was a significant difference between groups in histopathological score (p = 0.024). The epithelial immunohistochemical score of MMP-9 was significantly lower in group II than that in control group (p = 0.014). In conclusion, clarithromycin regresses endometriotic implants in rats, but not via MMP-9.

Evaluation of pain during hysterosalpingography with the use of balloon catheter vs metal cannula.

Our aim was to investigate the use of a balloon catheter device in comparison with metal cannula for hysterosalpingography (HSG) in terms of patient comfort. A total of 168 patients were randomised for HSG either with a balloon catheter (n = 83) or metal cannula (n = 85). Scores of pelvic pain during insertion of the devices, injection of the contrast medium and 1 h after the procedure were evaluated using the Wong Baker Faces Pain Rating Scale; complications and reinsertion rates were also noted. The pain scores were significantly lower in the balloon catheter group (p < 0.001). The reinsertion rate of metal cannula was higher (8.2% vs 2.4%) as well as the incidence of nausea being the most common short-term adverse effect (14.1% vs 1.2%) in the metal cannula group (p = 0.002). Performing HSG with a balloon catheter is advantageous for decreasing the pain and side-effects related to the procedure, when compared with the use of a metal cannula.

Evaluation of quality of life in fertile Turkish women with severe endometriosis.

We assessed the impact of pain, dysmenorrhoea and dyspareunia on the quality of life among Turkish fertile women with severe endometriosis. A total of 33 patients with histopathologically diagnosed severe endometriosis (Stage IV, revised criteria of the American Fertility Society (rAFS score) were enrolled into the study. Patients reported chronic pelvic pain using a visual analogue scale (VAS) and severity of dysmenorrhoea, dyspareunia and pelvic tenderness using the verbal rating scale (VRS). Quality of life (physical, psychological, social, environmental domains) was evaluated using the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF). There were no correlations between quality of life and VRS and VAS scores of chronic pelvic pain in patients with dyspareunia (p > 0.05). VRS in patients with dysmenorrhoea negatively correlated with physical, social and environmental dimensions of quality of life (r = -0.382, r = -0.221, r = -0.373 and p = 0.028, p = 0.013, p = 0.033, respectively). Although the severity of dysmenorrhoea seems to be related with lower quality of life, chronic pelvic pain and dyspareunia due to endometriosis may not have any deleterious effects on the quality of life.

Surgical management of extrauterine mislocated intrauterine contraceptive devices and related risks.

Our aim was to evaluate the value of surgery, mainly laparoscopy in the diagnosis of the location of extrauterine lost intrauterine devices (IUCDs) and their removal. The diagnosis and management of 18 patients with extrauterine lost IUCDs between 2007 and 2011, were recruited in this study. Women whose lost IUCDs were removed by conventional methods (D&C, etc.) and hysteroscopy, were excluded from the study. Laparoscopy was performed initially for the management of these cases. The location of the IUCDs and complications related with surgery were recorded. The results showed that the most common extrauterine localisation of the lost IUCDs was the omentum (n = 10, 55.6%). Overall, 17 laparoscopies and one cystoscopy were performed for IUCD removal. Out of two cases whose IUCD were located adjacent to the bowel, one case required a laparotomy for repair of the perforation site. It was concluded that lost IUCDs outside the uterine cavity can be managed by laparoscopy as a first choice. Since the most common extrauterine localisation of the lost IUCDs is the omentum, a thorough exploration of this area should be carried out initially.

Tumor markers panel and tumor size of ovarian dermoid tumors in reproductive age.

OBJECTIVE: To study whether there is any relationship between a serum tumor markers panel (CA19-9, CA 125, CEA, CA15-3 and AFP) and the tumor size in patients with ovarian dermoid cyst in reproductive age. BACKGROUND: Between January 2006-2007, 160 patients were operated in the Department of Infertility, Zekai Tahir Burak Women Health Hospital due to ovarian dermoid cyst. METHODS: The clinical data and serum tumor markers levels of operated patients were retrieved from the records of the department. This was a retrospective study. RESULTS: Forty-four patients (37.6 %) had high levels of CA 19-9 , twenty-seven patients (19.3 %) had high CA 125 levels, eleven patients (9.4 %) had high levels of CEA, five patients (4 %) had high levels of CA 15-3 and one patient (0.9 %) had high AFP levels at the time of initial surgery. The bilaterality rate was 8.1 %. When grouping the tumor size as 10 cm, the mean serum levels of tumor markers had significantly increased by increasing the tumor size (p<0.05) for CA 19-9, CA 125, CEA. CONCLUSIONS: Our study suggests that serum CA 19-9 is probably more accurate marker than other tumor markers in the ovarian dermoid cysts. Also, the most important parameter that affects CA 19-9 elevation in the dermoid cysts, is the tumor size. As the tumor becomes bigger, this relationship becomes more distinct (Tab. 2, Ref. 15).

Newborn hearing screening programme outcomes in a research hospital from Turkey.

BACKGROUND: Universal neonatal hearing screening programmes are encouraged to define and manage hearing loss in early ages of life. The aim of this study is to introduce our 14-month three-step hearing screening programme results with 16 975 births in Turkey. METHODS: In healthy neonates, Transient Evoked Otoacoustic Emission (TEOAE) is served as the initial screening in the first day of life. In newborns that did not meet pass criteria TEOAE was repeated in 10-day period. If the second test was 'refer' again, the screening was completed with auditory brainstem response (ABR). Additionally, ABR was performed for the neonates with neonatal intensive care unit (NICU) requirement and at high audiologic risk. Neonates who failed the screening test with ABR were referred for further evaluation. RESULTS: A total of 15 323 newborns and 1652 NICU infants were tested. The screening coverage was 94.4%; 14 521 neonates (94.7%) passed the first screening step (TEOAE), while 802 (5.2%) neonate failed. In total, 322 (40.1%) of the neonates out of 802 was subjected to the second TEOAE after 10 days have failed and ABR was applied. From the neonates participated the third step (ABR) totalling 1974, 43 (2.17%) of neonates obtained a 'refer' response. Out of these 43 neonates, 17 neonates were (39.5%) NICU infants. From the 43 neonates, 38 cases (88.4%) were found to have hearing impairment. The false-positive rate for first step screening with TEOAE was 4.9%; second step with TEOAE was 1.85% and for ABR was 0.25%. CONCLUSIONS: It is apparent that three step national hearing screening programme which has been applied for the latest years in Turkey is an accurate and non-invasive method to determine the congenital hearing loss. In the future, screening programmes could be rearranged with two steps as initial with TEOAE and retest with ABR and the coverage of the screening programme can be extended.